Endoscopic Management of Biliary Complications After Adult Living-Donor Versus Deceased-Donor Liver Transplantation

Gómez, Carlos Macías; Dumonceau, Jean‐Marc; Marcolongo, Mariano; Santibañés, Eduardo de; Ciardullo, M; Pekolj, Juan; Palavecino, Martín; Gadano, Adrián; Dávolos, Jorge

doi:10.1097/tp.0b013e3181bb48c2

Cited by 71 publications

(14 citation statements)

References 21 publications

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“…Some, such as hepatic artery thrombosis, have been identified as a risk factor; some, such as prolonged cold and warm ischemia, have been demonstrated to be associated with biliary complications, and some, such as donor type, are still conflicting. Several studies reported that the use of living donor graft was strongly correlated with biliary complications after transplantation as a result of a small duct size, the presence of multiple duct orifices, and devascularization of the bile duct (5,9,16,20). In the present study, no significant difference in overall biliary complications or the type of biliary complications between LDLT and DDLT recipients was observed.…”

Section: Discussioncontrasting

confidence: 43%

“…Several risk factors include primary underlying disease, type of donor, ABO incompatibility, ischemic time, surgical technique, hepatic artery problems, and rejection for the development of posttransplant biliary complications (4)(5)(6)(7)(8)(9)(10). Several studies previously demonstrated that endoscopic treatment modalities effectively treat the majority of biliary complications following liver transplantation (11)(12)(13)(14)(15)(16)(17)(18). The aims of the present study were to review biliary complications following liver transplantation in a single-center experience to identify the factors associated with the frequency of biliary complications, and to evaluate the success of endoscopic and percutaneous treatment modalities in such patients.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic treatment of biliary complications following liver transplantation

Seven¹,

Çınar²,

İdilman³

et al. 2014

Turk J Gastroenterol

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Section: Discussioncontrasting

confidence: 43%

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of biliary complications following liver transplantation

Seven¹,

Çınar²,

İdilman³

et al. 2014

Turk J Gastroenterol

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“…On the other hand, those of LDLT have been reported to occur more frequently: 7.3%-60.0% in right-lobe grafts[ 4 , 12 , 26 - 28 ] and 24% in left lateral segment grafts[ 29 ]. In a study by Gomez et al[ 30 ], biliary strictures occurred more frequently following LDLT than in DDLT [10/30 (33.3%) vs 27/357 (7.6%), respectively].…”

Section: Bile Duct Strictures: Ldlt Vs Ddltmentioning

confidence: 99%

Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

Rao

Prakash

Sudhindran

et al. 2018

WJG

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Biliary stricture complicating living donor liver transplantation (LDLT) is a relatively common complication, occurring in most transplant centres across the world. Cases of biliary strictures are more common in LDLT than in deceased donor liver transplantation. Endoscopic management is the mainstay for biliary strictures complicating LDLT and includes endoscopic retrograde cholangiography, sphincterotomy and stent placement (with or without balloon dilatation). The efficacy and safety profiles as well as outcomes of endoscopic management of biliary strictures complicating LDLT is an area that needs to be viewed in isolation, owing to its unique set of problems and attending complications; as such, it merits a tailored approach, which is yet to be well established. The diagnostic criteria applied to these strictures are not uniform and are over-reliant on imaging studies showing an anastomotic narrowing. It has to be kept in mind that in the setting of LDLT, a subjective anastomotic narrowing is present in most cases due to a mismatch in ductal diameters. However, whether this narrowing results in a functionally significant narrowing is a question that needs further study. In addition, wide variation in the endotherapy protocols practised in most centres makes it difficult to interpret the results and hampers our understanding of this topic. The outcome definition for endotherapy is also heterogenous and needs to be standardised to allow for comparison of data in this regard and establish a clinical practice guideline. There have been multiple studies in this area in the last 2 years, with novel findings that have provided solutions to some of these issues. This review endeavours to incorporate these new findings into the wider understanding of endotherapy for biliary strictures complicating LDLT, with specific emphasis on diagnosis of strictures in the LDLT setting, endotherapy protocols and outcome definitions. An attempt is made to present the best management options currently available as well as directions for future research in the area.

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“…Anastomotic biliary stricture was the most common complication associated with liver transplant (Table 5 ). The incidence of biliary stricture is higher in LDLT than in DDLT, 4 , 16 which might be explained by devascularization of the bile duct at the hilar dissection of the graft and the technical challenges of biliary reconstruction (eg, multiple-duct orifice and small ducts). All strictured bile duct cases in our study were successfully treated with endoscopic retrograde biliary drainage or PTBD.…”

Section: Discussionmentioning

confidence: 99%

Bile Duct Reconstruction by a Young Surgeon in Living Donor Liver Transplantation Using Right Liver Graft

et al. 2014

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Biliary strictures and bile leaks account for the majority of biliary complications after living donor liver transplantation (LDLT). The aim of this study was to examine differences in biliary complications after adult LDLTs were performed by an experienced senior surgeon and an inexperienced junior surgeon. Surgeries included bile duct reconstruction after adult LDLT using a right liver graft, and risk factors for biliary stricture were identified.We retrospectively reviewed the medical records of 136 patients who underwent LDLT in order to identify patients who developed biliary complications.The senior surgeon performed 102 surgeries and the junior surgeon performed 34 surgeries. The proportion of patients with biliary stricture was similar between the senior and the junior surgeons (27.5% vs 26.5%; P = 0.911). However, the incidence of biliary leakage was higher in patients of the junior surgeon than in those of the senior surgeon (23.5% vs 2.9%; P = 0.001). The frequency of percutaneous drainage was also higher for the junior surgeon than the senior surgeon because of the junior surgeon’s high leakage rate of the drainage. When the junior surgeon performed bile duct anastomosis, biliary leakage occurred in 7 patients between the 11th and 20th cases. However, biliary leakage occurred in only 1 case thereafter.Bile duct reconstruction performed by beginner surgeons in LDLT using right lobe grafts should be cautiously monitored and observed by a senior surgeon until an inexperienced junior surgeon has performed at least 20 cases, because of the high incidence of biliary leakage related to surgeon’s inexperience in bile duct reconstructions in LDLT.

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Endoscopic Management of Biliary Complications After Adult Living-Donor Versus Deceased-Donor Liver Transplantation

Abstract: Biliary complications were more frequent after LDLT compared with DDLT. Endoscopic treatment of anastomotic biliary strictures was successful in a minority of patients after LDLT, in contrast with DDLT. Most biliary leaks were successfully treated at endoscopy after LDLT or DDLT.

Cited by 71 publications

References 21 publications

Endoscopic treatment of biliary complications following liver transplantation

Endoscopic treatment of biliary complications following liver transplantation

Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions

Bile Duct Reconstruction by a Young Surgeon in Living Donor Liver Transplantation Using Right Liver Graft

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